Volkmann's ischaemic contracture

Last reviewed 01/2018

Volkmann's ischaemic contracture refers to contracture following circulatory occlusion of any kind. Most commonly, it is a complication of untreated compartment syndrome or a result of arterial injury. Ischaemia results in muscle necrosis and later, muscle fibrosis and shortening.

The condition is most commonly described in the forearm often as a complication of a supracondylar fracture of the humerus. Fibrosis in the flexor compartment pulls the fingers into flexion and the wrist into flexion and pronation. However, active extension of the fingers is possible when the wrist is passively flexed indicating that the contracture is in the forearm.

Treatment is difficult. The clawing deformity may be corrected by releasing the flexors at their origin but by itself, does not restore function. Nerve graft, usually using the proximal parts of the median and ulnar nerve, improves sensation, while tendon transfers, wrist extensors to finger and thumb flexors, allows active grip.

Contracture in the hand may develop from forearm injury or as a result of an overly tight forearm cast. There is a flexion contracture at the metacarpophalangeal joints but the interphalangeal joints are unaffected. The thumb is adducted across the palm.

In the calf, ischaemic contracture may cause clawing of the toes.